With SimplePractice you can generate Statements, Superbills, and CMS 1500 forms in a few simple steps! We've divided this article into the following three sections:
- First time checklist (check this section if this is the first CMS form you're creating in SimplePractice)
- Creating a CMS form
- Printing a CMS form
First Time Checklist
The first time you create a CMS claim form for a client, you’ll want to make sure you’ve entered the required data. Here are the three things to make sure you’re getting it right:
- Make sure you’ve filled out your practice information in your Practice Settings (name, address, license information, etc).
- Required fields are NPI number, office address, phone number, and tax number.
- Make sure your client's demographic and insurance information is set correctly. Most times this is done during the intake process.
- To check on this, click Edit Client Info.
- Required fields are the client's insurance insurance company, insurance Member ID, gender, birthday, phone number, and address.
- For more information about selecting your client's insurance company from the drop down list, check out this article: Selecting the right insurance provider and payer for your client.)
- Make sure that you’ve entered a Primary Diagnosis for the client, as well as set the appropriate CPT/Billing codes and rates for the client appointments.
- For more information, check out this article: Click here to learn how to create a diagnosis.
Creating a CMS form
Once you've checked this information, you're ready to create a CMS claim form. Here's how:
- Go to the Client Billing page. You can access it from the Client Profile page. You can also reach the Client Billing page from the session flyout on the calendar.
- Set the date range for the sessions you would like to include on the claim form. For example if you want all sessions in July, set the date range to: 7/1/2016 to 7/31/2016.
- Click +Create and select Claim/CMS1500. This will open up an editable form with all the CMS fields. Review the pre-populated information and add or edit any fields necessary.
Note: Don't worry, this isn't what the CMS form will look like when printed. The layout on this form is just for editing purposes. Your CMS Claim form prints just like a normal CMS form. For more information on pre-populating additional CMS fields, check out this article.
Once you have reviewed the information, you are ready to submit your claims. You have two choices:
- Electronic claim filing. If you're already enrolled, you'll see a blue Submit button at the top of the form. Click this to submit your claim to the insurance company. Click here to learn how to file a claim.
- Filing outside of SimplePractice. If you prefer to file the claim outside of SimplePractice, click the blue Save button at the top of the form. This will save the claim to the Client Billing page.
Note: If you're going to be filing your claim by mail or fax you will need to manually sign box 31 in order for the payer to process it.
Printing the CMS form
Here's how to print or download the claim form to file it outside of SimplePractice:
- Click Download at the top of the CMS 1500 claim page. A modal will pop up giving you two options:
- Download with form background will generate the fully filled out, red CMS 1500 form as a PDF.
- Download with form fields only will download only the data fields so you can print them out onto your own pre-printed CMS 1500 form. You can print it on your own blank CMS.
Note: When printing out either form, make sure the printer does not scale the page or add margins. If you print from Adobe Acrobat, these defaults should be set automatically.
- When printing out the full claim form with the red background, make sure your red ink cartridge is full and the red background prints without any streaks or faded color.
- When printing the data directly to a pre-printed claim form, we recommend adding the pre-printed claim form to your printer's main paper tray and not trying to print the form from an auxiliary paper tray.
- Remember that each printer is different so if your data fields don't print perfectly to the pre-printed claim form, you may have to tinker with the way you load the pre-printed forms in the paper tray and try the process again.